Kidney Stones

Not All Stones are Created Equal: Stone Analysis is Very Helpful

February 2010

It's important to recognize that not all kidney stones are the same, and that the pathophysiology of each type of stone is very different. The most common group of stones contains a majority of calcium oxalate, and account for about 70% of the total stones in the United States. The pathophysiology of this type of stone, commonly referred to as "idiopathic calcium oxalate stone disease," is the most complex of those listed, as we will subsequently discuss. Other common types of stones include uric acid, calcium phosphate and struvite, each accounting for another 10% of the total. Cystine stones are rarer and due to a specific genetic disorder. Finally certain drugs can precipitate in the urinary tract and form true drug stones.

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Jump to section:

• Introduction
• Kidney Stones
• Why do Kidney Stones Form?
• Genetics and Environment
• Not All Stones are Created Equal: Stone Analysis is Very Helpful
• Laboratory Evaluation
• Supersaturation Index
• Components of the Urinary Supersaturation Profile
• Uses of Urinary Supersaturation
• Common Features Increase Urinary Supersaturation in Patients with Idiopathic Calcium Oxalate Nephrolithiasis
• "Conservative" Dietary Recommendations for Calcium Oxalate Stone Formers
• Causes of Hypercalciuria
• Genetic Hypercalciuria
• Genetic Hypercalciuria: Treatment
• What is Oxalate?
• Hyperoxaluria: What is the Relevant Concentration?
• Oxalate Balance on a Typical Western Diet
• Enteric Hyperoxaluria is Caused by Fat Malabsorption
• Control of Urinary Citrate: Largely Due to Systemic Acid Base Balance
• Treatments for Enteric Hyperoxaluria
• Low Urinary Citrate
• Hyperuricosuria is a Risk Factor for Calcium Oxalate Stones
• Uric Acid is Very Insoluble at Low pH
• Calcium Phosphate is Very Insoluble at High pH!
• Cystine Stones
• Struvite stones
• Questions?